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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I saw an EMR demo today and they made a really interesting point about workflow. In fact, I was impressed that the EMR vendor admitted up front that you would need to change your clinic to work with their EMR software. I’ve said this a number of times on this site, but it was kind of refreshing to hear an EMR vendor admit it. I’ll have more on the rest of the demo/presentations in future posts.

What was most interesting was that after admitting that you would need to change the way you work to use an EMR, he made a really interesting and powerful point. The basic concept was that if you don’t have an EMR, your current workflow is bound by the paper world in which you now live. Hopefully, adding an EMR to the mix provides some new ways to serve patients that were impossible to accomplish in the paper world.

I think you could also add that implementing an EMR removes a bunch of paper queues. For example, we use to have a half sheet of paper that was filled out by the patient follow the patient throughout the entire visit. What were we going to do without that half sheet of paper? This is one of those workflow changes that isn’t a deal breaker, but just had to be considered and planned for.

Also, don’t confuse changes to your workflow with changes to how you treat a patient. Your workflow will absolutely change. We’ll save how an EMR affects how you treat a patient for another post.

7 responses to "EMR Implementations Change Workflow"

Actually, how you treat patients is likely to incrementally improve as the possibilities become apparent. To successfully climb a ladder, start with the first rung rather than peering up to the one on the top.
Successful EMR implementation start with the lower rungs and not just the last one at the top. The lower rungs may look and feel a lot as paper does. The upper ones are not likely to be very similar. But the key is achievable, non-disruptive elevations of what doctors do best.

Clearly, an EHR presents the potential for many changes to a client’s clinical processes or workflows. However, I suggest that this potential is better described by, “When adopting an EHR the vendor and the client must work together carefully to blend the advantages of the technology with the knowledge of the clinical staff and providers.”

Phrased accordingly, the potential for change is put in a way that recognizes the clear advantages that the EHR will provide, and also recognizes the many, many years of practice knowledge of the client.

To say flatly that workflows must change is not the most strategic way to discuss that potential and can immediately increase the level of fear in a client.

Further, any smart vendor will help their clients understand that the technology is far more flexible that the paper-based environment. Given that flexibility, many things can be customized to adapt to effective workflows that are already in place. That’s not to imply that an EHR simply adapt to inefficient paper-based processes. It does suggest that a smart vendor can help a client make the transition by flexing to the paper-based workflows that are working well.

Randall,
Certainly you have to take steps. However, I believe that many failed EMR implementations occur because people are too closely tied to their paper processes that they won’t consider what turns out to be more effective electronic processes.

Marty Martin,
Your description is better if your an EMR vendor or an EMR implementation consultant. I’m not really either (although sometimes I do the later and I may start advising the other), so as a blog that tries to keep things real I feel really good about telling people that their workflow is going to change.

Why? Because it’s going to change. You can add some flowery language to help people adopt that change better, but the reality is that life with an EMR will be different than life with paper charts.

Score some points for honesty. Another interesting wrinkle in all this is that there are also many products out there that stop short of requiring the sort of workflow change that has made the majority of physicians balk at using a full-fledged EMR.

These are products that aim to take only certain workflows digital, such as charge capture, lab reporting, eprescribing, patient sign out and the like. These solutions are often standalone and can hew more closely to how physicians actually work because their scope is more defined – no need to be so many things to so many different kinds of practices. When this approach works, physicians love it. Being able to work in a familiar way, paper or no paper, addresses the criticism doctors have consistently leveled at HIT vendors as a group: They don’t understand how medicine works.

What is interesting is that many of the products attempting to “get it right” from the physician perspective seem to be made by companies doing innovative work in applying web-based technologies to the needs of physicians. Chief among the approaches being taken is an attempt to marry the mass customization potential of the software-as-a-service approach and mobile smartphone technologies to the complex needs of physicians.

One reason why these technologies are not often noticed on the national EMR stage is that they are often found at small, innovative companies with a regional or even local following among physicians – they simply fly under the radar, doing quite well without fanfare. Maybe that will change now that it seems the Obama administration is pushing to make it easier for these companies to be certified for “meaningful use”.

As an executive working at one of them (Lime Medical, a maker of iPhone apps for charge capture and patient sign out), signs like this of a more level playing field are certainly welcome. Physicians might also find that it gets easier to avoid turning their entire practice upside down to “go digital”.

Hi John,
Interesting commentary. Of course, the other side of what you’re talking about is that many people would argue that if you keep doing the current paper capture, you’re still losing lots of data in the paper that can’t be reported on, checked against, easily displayed in a problem list, etc etc etc.

The other side would argue that the most important parts are being captured in the granular fashion or that there are some technologies that are being developed to try and capture free form data into usable discreet elements.

Lots of arguments both ways. It will be fun to see which side wins market share. So far meaningful use is requiring the discreet data elements one way or another.

This discussion is somewhat pedestrian. Workflow has been developed over centuries of medicine in patient treatment. Paper has been injected into this workflow as an advantage for managing increasingly larger amounts of information. For example, the half sheet that follows the patient, was injected to solve a problemof information in the workflow. That is not the same as changing information workflow to use the paper. Unfortunately, that is the bill of goods most EMRs try to sell. Change your workflow to use our EMR. The question should be how does your EMR inject itself into your information workflow to solve your problems. An EMR’s greatest asset is that it can be in multiple places at the same time, a workflow efficiency. Medscribbler’s additional asset, key for workflow injection, is that it can replace the physical format of paper in the information workflow gathering as well. Others must change the workflow and as a definition then become ineffecient to the patient care workflow learned over centuries.

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